Year 2010 temporary budget to make available the ... - Jersey City

BUSINESS ENTITY DISCLOSURE CERTIFICATION
FOR NON-FAIR AND OPEN CONTRACTS
Required Pursuant To N.J.S.A. 19:44A-20.8
CITY OF JERSEY CITY
Part I - Vendor Affrmation
The undersigned, being authorized and knowledgeable of the circumstances, does hereby certify that the -(name
of business entity;: has not made and wil not make any reportble contributions pursuant to N.J.S.A. 1 9:44A- i et
seq. that, pursuant to P.L. 2004, c. 19 would bar the award of this contract in the one year period preceding (date
of award scheduled for approval of the contract by the governing body) to any of the following named candidate
committee, joint candidates committee; or political par committee representing the elected officials of the City
of Jersev Citv as defined Dursuant to N.l.S.A. 19:44A-3( p), (Q) and (rt
Mariano Vega, Jr. Election Fund Gaughan Election Fund 2009
Friends of Peter Brennan Election Fund Steven Fulop forJersey City Inc.
Committee to Elect Wilie Flood Friends of Viola Richardson for Ward F
Friends of Michael Sottolano
Friends of Philip J. Kennv for Council Healy for Mayor 2009
Friends of Nidia Lopez
Part II - Ownership Disclosure Certfication
o I certify that the list below contains the names and home addresses of all owners holding 10% or more of the
is.sued and .outstadis.tock-Of.teundersign.
Check the box that represents the !rRe of business entity:
. AJl),- J"/'/I'-f '
o Partnership ~Corporation DSole Proprietorship o
Subchapter S Corporation
DLimited Partnership DLimited Liabilty Corporation DLimited Liabilty Partership
Name of Stock or Shareholder
,¡/A
Part 3 - Signature and Attestation:
ß/rf
Home Address
The undersigned is fully aware that if! have misrepresented in whole or par ths afirationand
certification, I and/or thebusine~s entity, wiltbe liable f?r any penal~y permitted :uder law. ../~.
Name of Business Entity: 'lhi . ~ ~/eø 6?~1. ,CD.~ ~/... ~ r I ~
Signatue of Afant: Title: éx~ ",U ro
Printed Name of Affant: "/L- Date: /ö/o. Ce /nlO,9
; 7 .
Subscribed and sworn before me ths day
of 6ar1)et , 2~. - RoLADD(2AMo~LAvA.f4 .
My Commssion expires:
ROlDO RAOS LAVARRO
. ID'23n189
CoB;ll
¡'.:,-.,';~...
(Witnessed or attested by)
(Seal)